TY - JOUR
T1 - Outcomes of surgical aortic valve replacement in moderate risk patients
T2 - Implications for determination of equipoise in the transcatheter era
AU - Iturra, Sebastian A.
AU - Suri, Rakesh M.
AU - Greason, Kevin L.
AU - Stulak, John M.
AU - Burkhart, Harold M.
AU - Dearani, Joseph A.
AU - Schaff, Hartzell V.
N1 - Funding Information:
Disclosures: The Division of Cardiovascular Surgery has a research grant titled “Randomized biological aortic valve replacement,” funded equally by Edwards Lifesciences , St Jude Medical , and the Sorin Group . Dr Suri is the Principal Investigator for the PERCEVAL IDE trial funded by the Sorin Group . Dr Park serves on the advisory board for Thoratec and the Cleveland Clinic. None of the disclosures pertain to the present investigation. All other authors have nothing to disclose with regard to commercial support.
PY - 2014/1
Y1 - 2014/1
N2 - Objective: To determine the contemporary outcomes of surgical aortic valve replacement (SAVR) in a moderate surgical risk population. Methods: We studied 502 consecutive adults who had undergone isolated SAVR from January 2002 to June 2011 for severe aortic valve stenosis with a Society of Thoracic Surgery predicted risk of mortality of 4% to 8%. We included concomitant coronary artery bypass and aortic annular enlargement but not other concomitant procedures. The updated Valve Academic Research Consortium definitions were used, as appropriate. Results: The median age was 80 years (range, 49-96), 323 (64.3%) had New York Heart Association class III-IV symptoms, and 101 (20.1%) had undergone previous coronary artery bypass grafting. The mean predicted risk of mortality was 5.6%. Concomitant coronary artery bypass grafting was performed in 270 (53.8%). Re-exploration for bleeding occurred in 29 (5.8%), stroke in 9 (1.8%), and vascular complications in 2 (0.4%). In the cohort, 14 early deaths (2.8%) occurred. During follow-up (1174 days), 175 patients died. Using multivariate logistic regression analysis, the significant independent predictors of mid-term death included chronic pulmonary disease (hazard ratio, 2.00, 95% confidence interval, 1.41-2.84; P <.001), peripheral vascular disease (hazard ratio, 1.58; 95% confidence interval, 1.05-2.37; P =.029), and atrial fibrillation (hazard ratio, 1.75; 95% confidence interval, 1.16-2.65; P =.008). Conclusions: SAVR in moderate-risk patients is currently performed with one half of the early predicted risk (2.8%) and a low likelihood of complications, including a 1.8% incidence of stroke. Patients counseled for randomization to transcatheter aortic valve insertion should be informed of the excellent early to mid-term outcomes of SAVR, particularly those without pulmonary impairment, peripheral vascular disease, or atrial fibrillation.
AB - Objective: To determine the contemporary outcomes of surgical aortic valve replacement (SAVR) in a moderate surgical risk population. Methods: We studied 502 consecutive adults who had undergone isolated SAVR from January 2002 to June 2011 for severe aortic valve stenosis with a Society of Thoracic Surgery predicted risk of mortality of 4% to 8%. We included concomitant coronary artery bypass and aortic annular enlargement but not other concomitant procedures. The updated Valve Academic Research Consortium definitions were used, as appropriate. Results: The median age was 80 years (range, 49-96), 323 (64.3%) had New York Heart Association class III-IV symptoms, and 101 (20.1%) had undergone previous coronary artery bypass grafting. The mean predicted risk of mortality was 5.6%. Concomitant coronary artery bypass grafting was performed in 270 (53.8%). Re-exploration for bleeding occurred in 29 (5.8%), stroke in 9 (1.8%), and vascular complications in 2 (0.4%). In the cohort, 14 early deaths (2.8%) occurred. During follow-up (1174 days), 175 patients died. Using multivariate logistic regression analysis, the significant independent predictors of mid-term death included chronic pulmonary disease (hazard ratio, 2.00, 95% confidence interval, 1.41-2.84; P <.001), peripheral vascular disease (hazard ratio, 1.58; 95% confidence interval, 1.05-2.37; P =.029), and atrial fibrillation (hazard ratio, 1.75; 95% confidence interval, 1.16-2.65; P =.008). Conclusions: SAVR in moderate-risk patients is currently performed with one half of the early predicted risk (2.8%) and a low likelihood of complications, including a 1.8% incidence of stroke. Patients counseled for randomization to transcatheter aortic valve insertion should be informed of the excellent early to mid-term outcomes of SAVR, particularly those without pulmonary impairment, peripheral vascular disease, or atrial fibrillation.
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U2 - 10.1016/j.jtcvs.2013.08.036
DO - 10.1016/j.jtcvs.2013.08.036
M3 - Article
C2 - 24094915
AN - SCOPUS:84890558140
SN - 0022-5223
VL - 147
SP - 127
EP - 132
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 1
ER -